Tumori pineale
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Transcript of Tumori pineale
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Tumorile PinealeTumorile Pineale
Cristina Aldea MG 3 Cristina Aldea MG 3
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Neurolege Nr.1Neurolege Nr.1
Orice tumorOrice tumoră cerebrală va avea manifestări ă cerebrală va avea manifestări clinice și evoluție tributareclinice și evoluție tributare ::
Naturii ei histologiceNaturii ei histologice
Topografiei acesteiaTopografiei acesteia
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AnatomiaAnatomia
...moare ultima......moare ultima...
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Glanda Pineală/EpifizaGlanda Pineală/Epifiza
Structură de linie medianăStructură de linie mediană
În strânsă relație anatomică cu:În strânsă relație anatomică cu: Apeductul lui SylviusApeductul lui Sylvius
Tectumul Mezencefalic(CCS!)Tectumul Mezencefalic(CCS!) Vena lui GalenVena lui Galen
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HistologiaHistologia
...greu de ucis II......greu de ucis II...
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2 tipuri de celule2 tipuri de celule PinealocitePinealocite
+ + restulrestul (cel. Interstițiale, (cel. Interstițiale, fagocite perivasculare,fagocite perivasculare, neuroni pineali, neuroni pineali, celule peptidergice neuron-like)celule peptidergice neuron-like)
Frecvent calcificată (săruri de Ca/F; după vârsta de 4 ani)Frecvent calcificată (săruri de Ca/F; după vârsta de 4 ani) - - nisip cerebralnisip cerebral (vizibil pe Rx)- (vizibil pe Rx)-
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EmbriologiaEmbriologia
...sport sângeros III......sport sângeros III...
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Ce se credea că face epifiza?Ce se credea că face epifiza?
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Pero Que hacPero Que hacé realmente la é realmente la epiphysisepiphysis??
- Ceasul intern al organismuluiCeasul intern al organismului contolează sist. Neuroendocrincontolează sist. Neuroendocrin ciclul somn-vegheciclul somn-veghe funcția sexualăfuncția sexuală
- - TRANSDUCTOR NEUROENDOCRINTRANSDUCTOR NEUROENDOCRIN
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Secretă:Secretă:
MelatoninăMelatonină (somn, apetit, hipotalamus, (somn, apetit, hipotalamus, hipofiză)hipofiză)
PinolinaPinolinaDMTDMT
!nu este izolată de restul corpului prin BHE!nu este izolată de restul corpului prin BHE
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Manifestări clinice ale tumorilor Manifestări clinice ale tumorilor pinealepineale
Datorate compresiunii structurilor vecine:Datorate compresiunii structurilor vecine:
1.Apeductul lui Sylvius: 1.Apeductul lui Sylvius: hidrocefalie obstructivă hidrocefalie obstructivă triventricularătriventriculară
(=(=>> HIC HIC netratat? – letargienetratat? – letargie poate evolua până la deces)poate evolua până la deces)
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2.2.CCS CCS
Nucleul Edinger-WestphalNucleul Edinger-Westphal Nervul OculomotorNervul Oculomotor
=> sdr. Parinaud=> sdr. Parinaud
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Sdr.ParinaudSdr.Parinaud
Paralizia mișcărilor verticaleParalizia mișcărilor verticale
PtozăPtozăParalizie de convergențăParalizie de convergențăPierderea reflexelor pupilare de acomodarePierderea reflexelor pupilare de acomodare
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3. Fibre cerebeloase eferente din PCS:3. Fibre cerebeloase eferente din PCS:
AtaxieAtaxie
DismetrieDismetrie
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Datorate naturii histologice:Datorate naturii histologice:
Pubertate pseudoprecocePubertate pseudoprecoce – bHCG din – bHCG din tum.germinaletum.germinale
Diabet insipidDiabet insipid
Amenoree secundarAmenoree secundarăă
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Clasificare (simplificată)Clasificare (simplificată)
Tumori Tumori din parenchimul pinealdin parenchimul pineal
pinealocitompinealocitom pinealoblastompinealoblastom celulele germinalecelulele germinale
non-germinalenon-germinale
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Investigație gold standardInvestigație gold standard
IRM cu contrast (Gadolinium)IRM cu contrast (Gadolinium)
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Ce e de făcut?Ce e de făcut?
Germinoame - radiosensibileGerminoame - radiosensibile
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Celelalte (chiar dacă 60 % sunt Celelalte (chiar dacă 60 % sunt ““benignebenigne””))
tratament neurochirurgicaltratament neurochirurgical
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Tratamentul neurochirurgicalTratamentul neurochirurgical
Are ca scop:Are ca scop:
Tratamentul hidrocefalieiTratamentul hidrocefaliei
Excizia tumoriiExcizia tumorii
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Tratamentul hidrocefalieiTratamentul hidrocefaliei
Drenaj ventriculo-peritonealDrenaj ventriculo-peritoneal
Ventriculocisternostomie endoscopicVentriculocisternostomie endoscopicăă
DVE?DVE?
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Excizia tumoriiExcizia tumorii
““The Creator did not intend frequent The Creator did not intend frequent neurosurgical intervention in this areaneurosurgical intervention in this area””
Richard DavidsonRichard Davidson
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Poziționarea pacientuluiPoziționarea pacientului
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CCăi de abordăi de abord
Supracerebelos infratentorialSupracerebelos infratentorial
Occipital-transtentorialOccipital-transtentorial
Parietal-interemsifericParietal-interemsiferic
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Vă mulțumesc Vă mulțumesc